On the Record with Dr. Ellen Grant

This transcript has been edited for clarity. Click a timestamp to jump to that point in the video.

00:00Ralph R. Ortega: …Dr. Ellen Grant, who is senior advisor for health care at O'Donnell & Associates. Welcome, Ellen.

00:10Dr. Ellen Grant: Hello, Ralph — and please call me Ellen.

00:13Ralph R. Ortega: Not a problem, Ellen. Thank you for joining us today, and thank you for taking some time out. Let's start off by asking: What stands out as the most significant development for health care and human services organizations in the state's fiscal year 2027 budget?

00:31Dr. Ellen Grant: I would say anything impacting health care right now, because of the amount of pressure that organizations are going under — the cuts that have happened at the national level in all areas of health, from infant development to senior care. I think those cuts are going to have a tremendously negative impact on how organizations are able to continue to maintain the current level of services that they have right now.

The cuts are going to happen as organizations have to reorganize, decide what services they can maintain, and how much staffing they can maintain and pay for. It's going to be tough times. People are dealing with Medicaid cuts right now, and we know that's going to be very real — that people are going to be figuratively thrown off the rolls for various reasons, which may not all be legitimate.

So I'm very concerned about how we're going to maintain services.

01:51Ralph R. Ortega: Is that what you're hearing? What are you hearing from health care organizations across the state as their biggest concerns heading into this fiscal year?

02:00Dr. Ellen Grant: Well, the concern is out there that they aren't going to be able to keep up with the level of… Right now we're all feeling the pressures of not having enough money and keeping up with the inflationary costs of services at all levels — from the medication to the human power, in terms of the number of people they'll be able to hire, or the number of people they will have to lay off because they can't afford to keep up with the cost of services.

02:41Ralph R. Ortega: Well, you're an expert on mental health care and behavioral health, right?

02:48Dr. Ellen Grant: Well, I'll do my best.

02:53Ralph R. Ortega: How are their concerns different from, say, hospitals, insurers or other kinds of health care organizations?

03:00Dr. Ellen Grant: Well, I think some of those concerns are similar, because if they're looking at Medicaid and insurance reimbursement — everyone dealing with any level of health care right now is concerned about the pressures of those costs. Even as an individual, I just got another update about what's going to be covered and what's not going to be covered, and medication is a big cost factor for most people, particularly if you're on a fixed-income budget.

I've had a list of medications that will no longer be covered, and fortunately I'm in fairly good health, so I don't have to worry so much about those. But people who are on fixed incomes — I've heard stories of people taking medication every other day because they cannot afford to take the medication that's necessary for their utmost health on a daily basis, and that's pretty sad.

Plus, we're hearing stories about SNAP benefits — people being able to afford groceries, not only for themselves but for their children. And that really concerns me. We already know that in the last couple of years, children have gone home from school with food to cover them through the weekend because they don't have enough resources to be able to feed themselves and their family, and that's very sad to me also.

04:47Ralph R. Ortega: That's got to be something that's on the radar screen for our lawmakers going into the session, right?

04:53Dr. Ellen Grant: No doubt.

04:53Ralph R. Ortega: I wanted to ask about the concerns with providers and staffing. That's been a big issue with nursing and even doctors. From your perspective, could you talk a little bit about where you see the greatest workforce shortages and difficulties with recruitment?

05:20Dr. Ellen Grant: Well, any level of caretaking in health care, I think, is an area that organizations who do the hiring are looking at. But I think also in the pipeline of educational institutions — in my own field of social work, I know that there is a lot of pressure for recruitment, to get people interested in those careers.

And then the outcome of people graduating: Are they going to stay in this area? Are there enough employment opportunities for them to stay in this area and take care of the health needs that the institutions have? How many are we going to lose out of this area to what they call the brain drain?

So I'm very concerned. I think organizations are looking at that too — and being able to keep up with the pay structure. I'm not sure that our pay structures for health care folks are meeting the needs of the economic pressures that we're all facing.

06:38Ralph R. Ortega: And the hospital networks have resorted to bringing in out-of-state professionals to try to fill the shortages, right?

06:49Dr. Ellen Grant: Absolutely. There are a lot of agencies that have sprung up, I think from the pandemic, that are still outsourcing resources — everyone from aides to nurses to probably even surgeons.

07:09Ralph R. Ortega: Wow.

07:09Dr. Ellen Grant: So that's of concern.

07:12Ralph R. Ortega: Which sector do you think is under the greatest pressure? Behavioral health, community health centers, substance abuse treatment, long-term care, safety-net providers?

07:20Dr. Ellen Grant: In my opinion, Ralph, I would say any of the caretaking professions and organizations — from infant care all the way up to senior care, we're seeing those pressures.

With infants, there aren't enough childcare workers, and that's a big concern that I have — that we aren't keeping up with the childcare industry in terms of the number of people to fill vacancies, because of the low payment that they receive. But also, the amount of money that it costs to have a child in childcare full time.

I know a physician, for example — a colleague of mine — who is paying $15,000 a year for basic childcare for one child, and she's got two. Right now she's using in-laws to help supplement the care. They have to parse out which child is going to get which grandma today, and which child is going to go to childcare today.

Those are legitimate decisions that parents have to make day by day. And think about the fact that you may have to give up your job to stay home and take care of your child because you can't afford the cost of childcare. To me, that's a real tragedy.

09:06Ralph R. Ortega: Oh my gosh, you're so right. And the governor has taken some measures to provide more money for childcare, and down in the city, we've got the 2-K program.

09:18Dr. Ellen Grant: Absolutely.

09:19Ralph R. Ortega: There are also geopolitical pressures, with the elimination of Temporary Protected Status for Haitians. That has threatened a pipeline of potential home health care workers.

09:38Dr. Ellen Grant: Home health care workers, but I think also in our hotel and other care industries. The immigration policies, I think, are going to hurt us all the way through every industry that we can imagine. But health care is a big one, where a lot of people from the immigrant population have come here to start a new life and end up in the caretaking industry.

And also in our farming industry. Who's going to get those crops taken care of so that we, the consumers, have the food available to us to eat? You're not going to have the average person out on the street going out to a farm for a job to pick crops. It hasn't happened yet. I don't think it's going to happen.

10:34Ralph R. Ortega: How are organizations really balancing demand with finite resources? Any examples?

10:45Dr. Ellen Grant: Well, I think it's really treading water right now — trying to see what are the most urgent needs that have to be taken care of, and then looking at what we can trim that we're no longer able to do.

I think everybody in any kind of health care or caretaking industry is looking at that right now. We're seeing in health care, for example, in research institutions, the number of grants that are being cut, which will impact the level of treatment that people are able to receive, because the grant for research in that particular area has been cut.

I'm very concerned about that. We may be hurting ourselves in the long run — with the next researcher who has the best design for a cure for cancer or the common cold, but that grant has been cut, and we're not able to maintain the development of that treatment.

12:03Ralph R. Ortega: Well, there are always opportunities. What are the biggest opportunities in this year's budget for these struggling organizations? They're treading water, as you said.

12:21Dr. Ellen Grant: In terms of the biggest opportunities, I think the governor is very open to hearing from the constituents — and the lawmakers who hear from the constituents — and bringing those concerns to the governor and the budget process.

Because of my background, I'm very concerned about mental health and how it's going to impact all of us — every person, from childcare all the way, as I said, to senior care. What budget resources are going to be put into those areas?

Because I think we have to be more proactive in taking care of a person's emotional development before it gets to the point where they're taking it out on themselves, or on society — not only suicide, but murdering other people, because they don't know how to deal with the stressors that they're under.

Until we get to the point where we can read people's minds, all we can do is provide the care that we think people are asking for and need.

13:47Ralph R. Ortega: So what are the greatest challenges for providers in translating these state health care goals into real-world outcomes?

14:00Dr. Ellen Grant: I just think, again, it's a balancing act — deciding what are the major needs that we have to make sure we're taking care of 24/7, and then how do we stretch out the resources, or what cuts can we make in a redesign or reorganization of services. I keep saying "tread water," because I think that's where we all are — kind of in a wait-and-see: what's going to happen at the state level, and what's going to happen at the national level, which will flow down and make us make some major decisions about services at the local level.

14:51Ralph R. Ortega: What role are community providers playing in all this?

14:55Dr. Ellen Grant: Well, I think they're being more proactive in making sure that the legislators — the lawmakers that they work with — know what their needs are. I think that in the last five years or so, folks who are at the executive level of these organizations are now taking a more proactive role by linking with legislators not only at the local level, but at the Albany level and at the Washington level. They know that they can't do it all by themselves.

So they're linking up with organizations like ourselves, O'Donnell & Associates, to get more boots on the ground for the services that they need to have covered in their own area of budgetary issues.

15:50Ralph R. Ortega: I agree. We both have fairly new roles here at O'Donnell. I'm helping to roll out public affairs campaigns that highlight the work that these organizations are doing.

I'll give you an example. It's a health care organization, but the AIDS Healthcare Foundation downstate is not only providing health care services — they're also providing affordable housing. It's not supportive housing, it's just affordable housing, and it's open to anyone.

16:28Dr. Ellen Grant: Wow. That's beautiful.

16:28Ralph R. Ortega: Yeah. They're not waiting around. They're taking action, as you said. So what about barriers to care? Are health organizations seeing any progress in reducing them?

16:44Dr. Ellen Grant: Well, thank goodness we had some federal legislation where, if a client shows up in an emergency room, they have to be seen; they have to be taken care of. But I think those health care organizations, in providing the free care that they are providing, are also seeing the gap in revenue, while still maintaining that safety net of providing care for those people.

I think the organizations that we have in health care and the not-for-profit area are doing the best that they can to meet the needs of the public. We're all feeling the inflation, but I'm also concerned that it's a struggle, particularly for those smaller organizations.

They're doing the best that they can in terms of marketing. I think maybe that's a gap that they haven't picked up on — they're realizing that they have to market their services, and it can be easily done. A lot of faith organizations, for example, are having health fairs to get their congregations involved in their own self-care for health services — everything from mental health services to heart care, to prostate care for men and breast care for women. Roswell Park, for example, has a health bus going to a lot of the not-for-profits to get constituents educated about self-care.

18:42Ralph R. Ortega: I'm glad you mentioned some of the good work that these organizations are doing. It's all about preventive health care, right? And screenings.

18:55Dr. Ellen Grant: Absolutely.

18:55Ralph R. Ortega: If they're not out in the community, who else is going to do it? Again, I'll give an example of AHF and one of their partners, ACQC in Queens. I was very fortunate, representing O'Donnell, to have gone down and written about — and taken pictures and film of — their free food market: a distribution of food, and also a way to promote their services and help the community learn what they're doing. And boy, oh boy, the line for that food market went three, four blocks. It was really, really long.

19:40Dr. Ellen Grant: I believe it.

19:40Ralph R. Ortega: All kinds of people, from all walks of life. At O'Donnell, we deal a lot with policymakers. Are they recognizing the connection between social services and health care outcomes?

19:57Dr. Ellen Grant: Oh, I think so. I do think so. We were fortunate — just last week we had a great panel in New York City on the topic of vitiligo. That's when the pigmentation leaves the skin — folks like Michael Jackson and Winnie Harlow, the model — and it's becoming more recognized.

I had a client, for example, who was trying to get social services, but she was often kind of brushed off when she went out in public and applied for a job, because people were so taken aback by the fact that she had these blotches of whiteness in her brown skin. They would just take her resume and say, "We'll call you if we find anything for you."

But we had a great panel discussion about it — about us needing to have that covered in New York State as a health care benefit. Would you believe there are states like Alabama and North Dakota that cover vitiligo services, and we in New York State aren't covering that? That seems like a misnomer to me. We've got to do better and make sure that it is not seen just as cosmetic care delivery — it's an autoimmune disease, and that's what it is. So I'm very glad that we had that panel in New York to make our legislators and the public more aware, so they're not taken aback by it.

21:44Ralph R. Ortega: Stigma is a horrible, horrible cloud that hangs over so many people's heads, over so many different health care conditions. I'm glad you're saying that. I think we will win that war one day.

21:58Dr. Ellen Grant: Yes. I mean, even with AIDS — people don't want to say it much outside, but I'm glad we're having more and more commercials, which to me are an educational piece for people to not be afraid — that you can still maintain a day-to-day life and still be under treatment for that disease.

22:22Ralph R. Ortega: I'll again mention AHF, because they deal with a lot of new clients who demand privacy. They are afraid. They don't want to give too much of their information. They don't want anyone to know. The stigma is still a very big problem today, even though people live with HIV — and with PrEP, their viral count can be almost nonexistent. What a difference from 40 years ago.

I've mentioned before, I'm writing a memoir about my parents, who unfortunately contracted HIV and passed away from complications in the late '90s and early 2000s.

23:10Dr. Ellen Grant: Oh, I'm so sorry.

23:10Ralph R. Ortega: It's an indiscriminate virus. Just a few more questions. What separates those organizations that can effectively engage Albany politics from those that struggle to have their voices heard?

23:30Dr. Ellen Grant: I think the amount of marketing that they do. And by marketing, I mean not just the executive director going to Albany or Washington, or even in the Western New York community — but that they get their whole advisory boards and community boards engaged.

That they have people who have the particular condition on their board, as a representative for the area that they're dealing with. And getting in front of those lawmakers at the local level, but also at the outsourced level, in Washington and Albany, as I've indicated. Those seem to be the ones that are most effective.

They beat their drum. They have the newsletter. They have health fairs. They invite lawmakers into the organization to see what they're doing. I think that's the special sauce.

24:35Ralph R. Ortega: And at O'Donnell & Associates, we help people navigate those Albany politics. So at what point in the budget process should a health care or human services organization begin engaging those policymakers?

24:50Dr. Ellen Grant: I think right from the day that the budget is passed. A lot of organizations think, "Whew, we missed a bullet; we can just sit down and relax." No — you have to keep at it, and we're an organization, as we like to say, that can help you in that regard.

And not just in the mental health arena, but in the environment. I'm very concerned about our environment, and Buffalo Niagara Waterkeeper is one of our clients that we engage with. This earth was put here by our Heavenly Father for us to maintain and keep the way it should be kept — the way He made it, so to speak.

So our water systems — I'm so saddened by the fact that we're still dealing with bad earth at Love Canal, and those reverberations that are continuing in our community. We thought we were done with this, but it's still there. We're dealing with issues like lead, and we know how that impacts the development of our children, and we're still dealing with lead elimination. I'm just praying for the day when we can get over this. I know that in our organization and among the lawmakers out there, we can work in unison and in a collaborative relationship to take care of some of these needs.

Our mental health agencies like Endeavor and Horizon, for example, are doing a great job. The Special Olympics — that is an area, too. It's not just mental health, but it's also physical issues that a lot of our children and adults are dealing with right now as they enter the workforce. We know organizations like Goodwill will hire them, but we want to see people who have any kind of emotional or physical development [challenge] engaged in the employment arena, so that they can also have the standard of living that they are entitled to.

27:26Ralph R. Ortega: And what are the biggest mistakes that you see organizations making most often?

27:33Dr. Ellen Grant: Most often, just not tooting their horn enough. And that goes back to the marketing again. Get on those TV shows; have those health fairs. Have at least one legislative day a year within your budget system to invite the lawmakers in and hear from them — but also, you as the agency, share with them some of the biggest needs that you have.

28:07Ralph R. Ortega: We're going to be wrapping up soon — just a couple more questions for you. And you know what? I agree. In my role in public affairs, I've had the wonderful opportunity, in such a short time, to help promote the advocacy of these organizations, like AHF and the Fund for the City of New York. We're working on these public affairs campaigns through our collaborative process at OD&A to highlight the good news, as they say. Folks always complain that they always get negative news, and now, with less and less local news, they don't get enough positive news.

Sometimes they think, "Oh, that doesn't sell newspapers," but it's amazing how curious people are to know what these organizations are doing for their communities — and they are doing good work. They are doing very, very good work.

So how has the advocacy environment changed for health care and human services organizations over the last decade? Has it changed a lot?

29:19Dr. Ellen Grant: I think it's been enhanced, just by the amount of service delivery that they have been able to do under these budgetary constraints. When you talk about good news being highlighted, I have to highlight my alma mater, the University at Buffalo, which is also a client, and the work that they're doing in the AI arena — which, as we know, can be very helpful but very scary too, at the same time.

So I'm hoping that as we put the new budget together — I think the governor is open to looking at this area and making sure that we have the stopgaps to make sure that it's not used in a negative way. I know the University at Buffalo is doing a lot of work in AI, and also in their own health research area. So I'm glad that they're a client and that we're working in collaboration with them.

30:28Ralph R. Ortega: And I'm glad you mentioned the governor, because we have a pretty strong relationship with her at O'Donnell, and she is sensitive to these issues. So what policy issue do you believe isn't getting enough attention in Albany and deserves greater focus?

30:48Dr. Ellen Grant: Well, I'm sorry, I have to say mental health. I have to say mental health, because it does impact the entire physical system. If you're not well mentally, it is going to impact you physically, and if you're not feeling well physically, it is also going to impact you mentally.

So everything from, again, childcare to senior care — we have to be aware of those touch points that are going on. You can see what's going on right now with the schools, with the bullying, with the pressures that children are feeling that they have to measure up to certain standards [set] by some maybe AI-developed person who's on TikTok, or some person that they see as their ideal.

And thank goodness that the governor was proactive in making sure that all technology is locked up as the child enters that educational arena. Too bad we can't police what goes on after school and what goes on in those children's homes. But during the school day, they have to be focused on what's going on in school.

32:12Ralph R. Ortega: That was a great success for the governor, getting that cellphone restriction.

32:16Dr. Ellen Grant: Absolutely.

32:16Ralph R. Ortega: If you were advising health care and human services leaders, what should they be prepping for over the next two to three years? We still have two more years of the Trump administration.

32:30Dr. Ellen Grant: Well, again, I have to say mental health — and not just mental health, but also substance abuse. I just heard last week there's another medication that is stronger than fentanyl that is being marketed on the street to people who need drugs, and it's killing people. So I'm very concerned: Do we have enough stockades in place for what's going on in the substance abuse area?

33:02Ralph R. Ortega: And what does success look like in New York's health care and human services system moving forward?

33:11Dr. Ellen Grant: Success, to me, looks like: What are we doing for the children? What are we doing for the children and all of their needs and development? Because they're going to be the ones taking care of us, and if they're not healthy, then God help us all.

33:33Ralph R. Ortega: I agree. And I want them to look back at us and say we made good decisions for them.

33:41Dr. Ellen Grant: Absolutely right.

33:42Ralph R. Ortega: Is there a question that you wanted me to ask that I didn't, or some final thoughts you want to add before we wrap up?

33:54Dr. Ellen Grant: That we are all going to be under some stressors over the next couple of years, and I think we just have to do the best that we can with the tools that we have. That's really all we can do — and just keep praying.

34:15Ralph R. Ortega: Well, this was really terrific. Thank you so much again for joining me on this interview. Your insights are very helpful, and I'm looking forward to having more of these discussions moving forward, as we work with our clients at O'Donnell & Associates and do these videos and podcasts. Thank you again.

34:40Dr. Ellen Grant: Thank you, Ralph.